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Here in Scottsdale, JCAHO requires photographic evidence of said tattoo. Cell phone preferably.
Clinical Scenarios for the ABSITE, etc.
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Here in Scottsdale, JCAHO requires photographic evidence of said tattoo. Cell phone preferably.
11. Which of the following is the most appropriate treatment for coagulopathy secondary to uremia?
a. Cryoprecipitate
b. Vitamin K
c. Factor VII
d. DDAVP
e. Protamine
Correct. Coagulopathy of uremia is multifactorial in real life...patients get meds like heparin and aspirin, etc...but the classic ABSITE cause is alterations in the function of vWF and GpIIb/IIIa, which causes platelet dysfunction. DDAVP is an appropraite treatment, as is dialysis itself.
I found this medscape article when trying to remember the IIb/IIIa crap, and it seems good at a glance.
I also want to remind the junior residents that von Willebrand's Disease shows up on the ABSITE all the time...you should probably memorize the different types (I, II, and III) and the treatments.
Other things that show up on the junior exam frequently:
1. Multiple Endocrine Neoplasia...just memorize it once and for all.
2. Statistics questions: T-test, ANOVA, Type I/II error
3. Physiologic effects of pneumoperitoneum
4. Changes in pulmonary dynamics with PEEP and with age
5. Anal squamous cell cancer
6. Trauma trauma trauma....maybe even pregnant trauma (trauma for the baby mama).
7. Blood supply to cystic duct/head of pancreas/conduit after esophagectomy.
8. When to transfuse platelets during splenectomy for ITP (I still don't know the "test" answer to this one, and I've looked pretty hard)
9. Anatomy of the anterior and/or posterior triangles of the neck
10. PFTs needed to tolerate lobectomy
11. Side effects of anesthesia drugs (etomidate=adrenal insufficiency, pancuronium=tachycardia, succ=malignant hyperthermia)
12. Sudden rises and decreases in ETCO2 during a case
13. Fat embolus after a femur fracture
14. FNAs of thyroid masses, interpretation of path
Honestly, there's about 50-75 buzz topics that are commonly on the ABSITE in one form or another. Luckily, most of the review books know this, and address these topics. It is essential that you use a review book to study, and it is silly to use a textbook in the month of January.
Good luck, everyone.
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ABSITE isn't today (last Saturday in Jan)?
I agree my advice could have been more timely, but my understanding is that the exam is now spaced out over several days (starting today), and the last group of residents will take it on Monday or Tuesday.
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Yes. Our program has some that took it today, some tomorrow, and some Monday.
As I am "on call" (new stupid junior call that is only ~14 hours long) last night and tonight, I am taking it Monday.
I just finished going over all the things listed as incorrect on last year's exam read out. I really hope that gets me at least 1-2 questions I might have otherwise missed because it was painful.
For future exams, the fastest way to research your wrong answers is to use the Richard E. Dean ABSITE review manual, as it's basically a recount of all of the previous year's questions. Of course, sometimes they are sort of off the mark.
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I just hate all the GI hormones, because I have no organized way of remembering them.
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After the splenic artery is ligated, so you don't keep consuming those platelets. At least, that's what I think.
You'll get to know them after a while, when you learn them in some sort of context...we kept talking about them on Surg Onc rounds because of patients with gastrinomas, gastrectomies with Roux-en-Ys, peptic ulcer disease, etc.
That's my point. There are 4 or 5 "correct" answers, and you never know which one is the special answer that is ABSITE correct.
-Only transfuse if they bleed (my real-life answer)
-Transfuse after ligating the splenic artery (you know after most of the bleeding risks has passed)
-Transfuse with induction of anesthesia
-With incision
-30 minutes prior to incision.........
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Oh, I was told to transfuse after splenic artery ligation since that takes the spleen's ability to consume those platelets out of the equation.
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That's what I've heard.
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Apologies...my query was not meant as a dig at you. I had heard rumors of the dates changing and was curious. Thanks for the update.
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Me too.
Real life scenario: how high does the platelet count need to be to take a thrombocytopenic patient to the OR for a splenectomy? I'm not talking about regular procedures, or chemo patients needing ports. I got curbsided on a patient whose platelet count wouldn't even transiently hit double digits after multiple-pack platelet transfusions before they had finished the heme work up. I realize the count will go up after you ligate the artery, but getting in to the belly could be a blood fest.
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I just looked up an article on this, and DDAVP was listed as a treatment, but so was cryo and/or aminocaproic acid. http://hpboardreview.com/pdf/hp_may01_uremic.pdf
The cryo was listed as a second-line agent, but it doesn't clearly state if the aminocaproic acid is ever an appropriate first-line agent. Thoughts?
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I thought Dialysis is 1st/best.
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That's usually only used for tPA overdoses.
Has anyone actually ever used aminocaproic acid for a tpa overdose? It seems like it's very poorly tolerated, and there's a high risk of thrombosis. I remember thinking previously that there's actually a better approach to reversing TPA. Of course, now I can't remember what it was.....
I think DDAVP is quick and easy, and appropriate for pre-operative treatment to prophylax a uremic patient. Cryo is more expensive and exposes the patient to transmission risks.
Link that article, though, if you would. Coagulopathy of uremia is sort of an elusive subject. The ABSITE will only have 1 right answer, of course, but in real life there are options.....
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I haven't. Then again, my only exposure to tPA has been when unclogging CVL/PICC lines, or the rare time I've seen IR do a provocative angio for occult GI bleeding.
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Never for a thrombosed graft?
Only side effect I've seen from tPA was a pretty big stroke, and I don't recall that the patient got any aminocaproic acid.
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Ah, yes, that happens, but I've never been involved with that.
